In less than 3 months, the Health Insurance Marketplace or “Exchange” will begin open enrollment as required by the Affordable Care Act (ACA). Many Americans remain unaware of the ways this will affect their health insurance coverage and many states are still debating plans to expand their Medicaid programs.  As part of our ongoing commitment to our clients, we are pleased to announce several enhanced services that will ensure you have the information and resources needed throughout this transition. Our goal remains to provide you and your patients / clients / consumers with the ClaimAid Advantage.

The “Employer Mandate” has been delayed until 2015. 

  • The ACA requires companies with 50 or more employees to make a “shared responsibility payment” of as much as $3,000 per employee if they don’t provide affordable insurance. The Obama administration stated that it would not begin enforcing this part of the law until 2015. The “individual mandate,” that requires people to acquire coverage remains in effect.
  • What you need to know: Businesses that were required by the ACA to offer insurance, or improve existing plans to meet minimum essential coverage standards, may wait an additional year to do so. Though many employers already offer coverage, individuals who may have gained access to coverage through the mandate may now be eligible for the tax subsidy in the Health Insurance Marketplace.

Indiana Navigator Program established through the Indiana Department of Insurance.

  • The Indiana Family and Social Services Administration (FSSA) has established an Indiana Navigator program through a partnership with the Indiana Department of Insurance to include those who complete Medicaid applications for others.
  • What you need to know: ClaimAid staff will be certified by the state of Indiana to complete Medicaid applications and by the federal Health Insurance Marketplace for enrollment assistance in tax subsidized commercial insurance plans. This includes the required background checks, training, testing and annual continuing education for both the state and federal programs. ClaimAid advocates will also meet conflict of interest, ethical and legal standards.

“Encouraging signals” from CMS regarding the Healthy Indiana Plan (HIP) waiver application.

  • Indiana Family and Social Services Administration leadership met with the Centers for Medicare and Medicaid Services (CMS) in June to discuss the HIP waiver application.
  • What you need to know: The consensus is that CMS will approve the extension rather than “transition” the 37,000 current HIP participants out of the program. FSSA has stated that it will cease enrollment of new members in August and begin to modify contracts with health plans if the waiver request is denied. The use of the HIP as an option for Medicaid expansion is not part of this initial negotiation, and FSSA has stated that those conversations may only begin after the waiver application discussions have been completed. ClaimAid has the experience and up-to-date information to assist patients in this dynamic environment.

Public awareness of the Affordable Care Act remains low among the Uninsured.

  • Recent Gallup polling indicates that only 56% of uninsured Americans are aware that they are required to purchase insurance or pay a fine and 34% are not familiar with the ACA.
  • What you need to know: 

    Federal and state funding for consumer education is extremely limited. As awareness of the ACA increases in the coming months, more people will turn to their health care providers for answers. ClaimAid will continue to work with clients to provide education, information and facilitate enrollment into an appropriate coverage option. Contact us now to schedule a time to meet with your team to discuss your strategic plans for transition.

For more details and up-to-date information, please contact J Hopkins, Vice President at 800.842.4052 x126 or by email at